Mikeisha Brannock, RDN
Individual provider Active NPI Registered Dietitian · Supply, NC
NPI 1962215293 · NPPES record last updated Jan 30, 2025
Key facts
- NPI
- 1962215293
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- Practice address
- 20 Medical Campus Dr NW Ste 206
Supply, NC 28462-4094 - Phone
- (910) 239-3562
- NPI assigned
- Jan 30, 2025
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Registered Dietitian Or Nutrition Professional
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Nutrition in Motion
Practice addresses (Care Compare)
1016 2ND Ave N
Suite 206G
North Myrtle Beach, SC 29582-8209
Phone (910) 239-3562
20 Medical Campus Dr NW
Suite 206
Supply, NC 28462-4094
Phone (910) 239-3562
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NC, SC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250326001941 | NC | Practitioner - Registered Dietitian Or Nutrition Professional | 9032632419 | Reassigns benefits to 1 organization |
| I20260114000094 | SC | Practitioner - Registered Dietitian Or Nutrition Professional | 9032632419 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3101 | SC | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nutrition in Motion | Dietitian, Registered | Current |
Accepting new patients |
| Norma J Cortez DDS PA | Past | Accepting new patients |
Locations
20 Medical Campus Dr NW
Ste 206
Supply, NC 28462
Phone (910) 754-5453
2517 Delaney Ave
Wilmington, NC 28403
Phone (910) 251-7755
1133 Medical Center Dr
Wilmington, NC 28401
Phone (910) 763-0931
1016 2nd Ave N
Ste 206G
North Myrtle Beach, SC 29582
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | Yes |
Addresses
Primary practice location
20 Medical Campus Dr NW Ste 206
Supply, NC 28462-4094
Mailing address
2517 Delaney Ave
Wilmington, NC 28403-6003
Phone (910) 239-3562
Other providers in Supply, NC
- Currin Louise Bender
- Sarah Katelyn Bender
- Bio-Medical Applications of North Carolina, Inc.
- Bowman Place
- Brandon E. Devito, DDS, PLLC
- Tonya Renee Brock
- Kusanya Amice Brooks
- Benjamin Bryan Browning
- Hannah Jo Browning
- Brunswick Cardiology
All providers in Supply, NC · Registered Dietitian in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 30, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.